Abstract Number: PB0430
Meeting: ISTH 2020 Congress
Theme: Diagnostics and OMICs » Biomarkers of Thrombosis and Hemostasis
Background: Patients with suspected heparin-induced thrombocytopenia (HIT) have a high incidence of major bleeding (Pishko, JTH 2019). Recent studies have implicated elevated soluble glycoprotein VI (sGPVI) levels as a risk factor for bleeding (Muthiah, JHLT 2016).
Aims: To determine if elevated sGPVI plasma levels are associated with major bleeding events in patients with suspected HIT.
Methods: We utilized a cohort of 310 hospitalized adult patients with suspected HIT, who had a citrated plasma sample collected at the time HIT was suspected. Plasma sGPVI levels were measured by ELISA. Patients transfused with platelets within 1 day of specimen collection were excluded because of the presence of high levels of sGPVI in platelet concentrates. We reviewed the electronic health record for ISTH major bleeding events from time of sample collection to hospital discharge or death. We compared median sGPVI levels between patients with and without major bleeding events. We selected a dichotomous cut-off point for sGPVI that maximized the associated Youden’s index. We then assessed the association of sGPVI with bleeding outcomes by multivariable logistic regression, adjusting for other clinical risk factors for bleeding.
Results: 54 patients were excluded due to recent platelet transfusion. 34.8% of patients had a major bleeding event. Table 1 displays clinical features by bleeding outcome. Median sGPVI levels were significantly elevated in patients with major bleeding events compared to those without major bleeding events (49.09 ng/mL vs. 31.93 ng/mL, p< 0.001). The odds of a major bleeding event were 3.07 times (95% CI 1.67-5.64) greater in patients with a sGPVI level ≥43 ng/mL after controlling for platelet count, sepsis, and critically ill status (Table 2).
Conclusions: In this cohort of patients with suspected HIT, sGPVI was associated with major bleeding. sGPVI may be a novel biomarker to predict bleeding risk in patients with suspected HIT.
| Bleeding Event N=89 |
No Bleeding Event N=167 |
p-value | |
| Age , Median (range) | 65(19-86) | 67(24-92) | 0.373 |
| Critical Care, n (%) | 66(74.2%) | 68(40.7%) | <0.0001 |
| Surgery, n (%) Cardiac Bypass Non-Cardiac Bypass |
39(43.8%) 14(15.7%) |
47(28.1%) 29 (17.4%) |
0.011 0.739 |
| Sepsis, n (%) | 38(42.7%) | 38(22.7%) | 0.001 |
| Platelet Count on day of blood collection x 109/L | 54.5(8-200) | 79(13-422) | 0.0004 |
| Serotonin Release Assay Positive, n (%) | 10(11.2%) | 15(9.0%) | 0.863 |
| Platelet Factor 4/Heparin ELISA ≤0.4 0.4-1.0 1.0-2.0 ≥2.0 |
63(70.8%) |
117 (70.1%) |
0.722 |
[Table 1. Clinical features of patients with and without bleeding events]
| Univariable Logistic Regression | Multivariable Logistic Regression | |||
| OR (95% CI) | p-value | OR (95% CI) | p-value | |
| sGPVI <43 ng/mL ≥43 ng/mL |
1(ref) 4.59(2.65-7.96) |
– <0.001 |
1(ref) 3.07(1.67-5.64) |
– <0.001 |
| Critical Illness No Yes |
1(ref) 4.18(2.37-7.36) |
– |
1(ref) |
– |
| Sepsis No Yes |
1(ref) 2.52(1.45-4.40) |
– 0.001 |
1(ref) 1.72(0.91-3.26) |
– 0.092 |
| Platelet Count x109/L >151 100-150 50-100 <49 |
1(ref) |
– |
1(ref) |
– |
[Table 2. Univariable and multivariable logistic regression model for bleeding]
To cite this abstract in AMA style:
Pishko A, Andrews R, Gardiner E, Lefler D, Cuker A. Soluble Glycoprotein VI is an Independent Predictor of Major Bleeding in Patients with Suspected Heparin-Induced Thrombocytopenia [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/soluble-glycoprotein-vi-is-an-independent-predictor-of-major-bleeding-in-patients-with-suspected-heparin-induced-thrombocytopenia/. Accessed September 29, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/soluble-glycoprotein-vi-is-an-independent-predictor-of-major-bleeding-in-patients-with-suspected-heparin-induced-thrombocytopenia/